Healthcare Provider Details

I. General information

NPI: 1699682260
Provider Name (Legal Business Name): MISTY GRIBBLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 COUNTRY CLUB RD
CHADRON NE
69337-7326
US

IV. Provider business mailing address

222 COUNTRY CLUB RD
CHADRON NE
69337-7326
US

V. Phone/Fax

Practice location:
  • Phone: 308-430-4681
  • Fax:
Mailing address:
  • Phone: 308-430-4681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: